
{include file="pageheader.htm"}

<script src="js/utils.js" ></script>


<form method="post" action="?page=customer&action=savenew" name="theForm" >


  <!-- start order view -->
  <div class="list-div" id="listDiv">					  

<table cellpadding="3" cellspacing="1">

  <tr>
    <td >{$lang.language}</td>
    <td >{$lang.customer_name}</td>
    <td >{$lang.customer_fname}</td>
    <td >{$lang.label_sex}</td>    
    <td> {$lang.label_age}</td>
  <tr>

  <tr>
    <td >
	<select name="member[language]" size="1">
        <option value="japanese" selected="selected">japanese</option>
        <option value="english">english</option>
        <option value="portugues">portugues</option>
      </select>  

	  </td>
    <td >
	last name: <br />  
    <input type="text" name="member[customer_lname]"   /> <br />
    first name:<br />  <input type="text" name="member[customer_fname]"    />
	</td>

	<td>
	kana_last_name:<br />
          <input type="text" name="member[customer_lname_kana]"  />
    kana_first_name:<br />
        <input type="text" name="member[customer_fname_kana]"  />
	</td>

    <td ><select name="member[customers_sex]" size="1" id="member[customers_sex]">
        <option value="1" selected >male</option>
        <option value="2">female</option>
      </select>  
	  </td>    
    <td><input type="text" name="member[customers_age]"   size="2" /></td>
  <tr>

<!-- address info -->

 <tr><td colspan=5> {$lang.address} </td></tr>

<tr>
<td>{$lang.country}: <br />
	<input type="text" name="member[country]"   /></td>
<td>{$lang.prefecture}:<br />
<input type="text" name="member[prefecture]"   /></td>
	<td>
	{$lang.city}:<br />
	<input type="text" name="member[city]"   />
	</td>
	<td>
	{$lang.postcode}:<br />
	<input type="text" name="member[postcode]"  />    
	</td>
<td></td>
</tr>

  <tr><td colspan=5>
  {$lang.address}:<br />
	      <input type="text" style="width:80%" name="member[address]"  />
  </td></tr> 

  <tr>
    <td >{$lang.telephone}</td>
    <td >{$lang.faxnumber}</td>    
    <td >{$lang.memberno}</td>
	<td >{$lang.loginid}</td>
    <td> {$lang.mailaddr}</td>
  <tr>

  <tr>
    <td ><input type="text" name="member[phone_number]"   /> </td>
    <td ><input type="text" name="member[fax_number]" /></td>
    <td ><input type="text" name="member[customer_no]" /></td>
    <td ><input type="text" name="member[login_id]" /></td>    
    <td> <input type="text" name="member[customers_mail]" /></td>
  <tr>
 

</table>

</div>	

<div class="list-div" id=idFormSubmit  >
<table>
	<tr><td align=center ><input type=submit name=submit value="{$lang.submit}" ></td></tr>
</table>
</div>

</form>
<!-- end person view -->

<br /> 
 

{include file="pagefooter.htm"}